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The Tacrolimus Concentration/Dose Ratio Does Not Predict Early Complications After Kidney Transplantation

Early-on post kidney transplantation, there is a high risk of graft rejection and opportunistic viral infections. A low tacrolimus concentration/dose (C/D) ratio as a surrogate marker of fast tacrolimus metabolism has been established for risk stratification 3 months post-transplantation (M3). Howev...

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Autores principales: von Samson-Himmelstjerna, Friedrich Alexander, Messtorff, Maja Lucia, Kakavand, Nassim, Eisenberger, Ute, Korth, Johannes, Lange, Ulrich, Kolbrink, Benedikt, Aldag, Leon, Schulze Dieckhoff, Tobias, Feldkamp, Thorsten, Kunzendorf, Ulrich, Harth, Ana, Schulte, Kevin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10203205/
https://www.ncbi.nlm.nih.gov/pubmed/37229240
http://dx.doi.org/10.3389/ti.2023.11027
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author von Samson-Himmelstjerna, Friedrich Alexander
Messtorff, Maja Lucia
Kakavand, Nassim
Eisenberger, Ute
Korth, Johannes
Lange, Ulrich
Kolbrink, Benedikt
Aldag, Leon
Schulze Dieckhoff, Tobias
Feldkamp, Thorsten
Kunzendorf, Ulrich
Harth, Ana
Schulte, Kevin
author_facet von Samson-Himmelstjerna, Friedrich Alexander
Messtorff, Maja Lucia
Kakavand, Nassim
Eisenberger, Ute
Korth, Johannes
Lange, Ulrich
Kolbrink, Benedikt
Aldag, Leon
Schulze Dieckhoff, Tobias
Feldkamp, Thorsten
Kunzendorf, Ulrich
Harth, Ana
Schulte, Kevin
author_sort von Samson-Himmelstjerna, Friedrich Alexander
collection PubMed
description Early-on post kidney transplantation, there is a high risk of graft rejection and opportunistic viral infections. A low tacrolimus concentration/dose (C/D) ratio as a surrogate marker of fast tacrolimus metabolism has been established for risk stratification 3 months post-transplantation (M3). However, many adverse events occurring earlier might be missed, and stratification at 1 month post-transplantation (M1) has not been investigated. We retrospectively analyzed case data from 589 patients who had undergone kidney transplantation between 2011 and 2021 at three German transplant centers. Tacrolimus metabolism was estimated by use of the C/D ratio at M1, M3, M6, and M12. C/D ratios increased substantially during the year, particularly between M1 and M3. Many viral infections and most graft rejections occurred before M3. Neither at M1 nor at M3 was a low C/D ratio associated with susceptibility to BKV viremia or BKV nephritis. A low C/D ratio at M1 could not predict acute graft rejections or impaired kidney function, whereas at M3 it was significantly associated with subsequent rejections and impairment of kidney function. In summary, most rejections occur before M3, but a low C/D ratio at M1 does not identify patients at risk, limiting the predictive utility of this stratification approach.
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spelling pubmed-102032052023-05-24 The Tacrolimus Concentration/Dose Ratio Does Not Predict Early Complications After Kidney Transplantation von Samson-Himmelstjerna, Friedrich Alexander Messtorff, Maja Lucia Kakavand, Nassim Eisenberger, Ute Korth, Johannes Lange, Ulrich Kolbrink, Benedikt Aldag, Leon Schulze Dieckhoff, Tobias Feldkamp, Thorsten Kunzendorf, Ulrich Harth, Ana Schulte, Kevin Transpl Int Health Archive Early-on post kidney transplantation, there is a high risk of graft rejection and opportunistic viral infections. A low tacrolimus concentration/dose (C/D) ratio as a surrogate marker of fast tacrolimus metabolism has been established for risk stratification 3 months post-transplantation (M3). However, many adverse events occurring earlier might be missed, and stratification at 1 month post-transplantation (M1) has not been investigated. We retrospectively analyzed case data from 589 patients who had undergone kidney transplantation between 2011 and 2021 at three German transplant centers. Tacrolimus metabolism was estimated by use of the C/D ratio at M1, M3, M6, and M12. C/D ratios increased substantially during the year, particularly between M1 and M3. Many viral infections and most graft rejections occurred before M3. Neither at M1 nor at M3 was a low C/D ratio associated with susceptibility to BKV viremia or BKV nephritis. A low C/D ratio at M1 could not predict acute graft rejections or impaired kidney function, whereas at M3 it was significantly associated with subsequent rejections and impairment of kidney function. In summary, most rejections occur before M3, but a low C/D ratio at M1 does not identify patients at risk, limiting the predictive utility of this stratification approach. Frontiers Media S.A. 2023-05-09 /pmc/articles/PMC10203205/ /pubmed/37229240 http://dx.doi.org/10.3389/ti.2023.11027 Text en Copyright © 2023 von Samson-Himmelstjerna, Messtorff, Kakavand, Eisenberger, Korth, Lange, Kolbrink, Aldag, Schulze Dieckhoff, Feldkamp, Kunzendorf, Harth and Schulte. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Health Archive
von Samson-Himmelstjerna, Friedrich Alexander
Messtorff, Maja Lucia
Kakavand, Nassim
Eisenberger, Ute
Korth, Johannes
Lange, Ulrich
Kolbrink, Benedikt
Aldag, Leon
Schulze Dieckhoff, Tobias
Feldkamp, Thorsten
Kunzendorf, Ulrich
Harth, Ana
Schulte, Kevin
The Tacrolimus Concentration/Dose Ratio Does Not Predict Early Complications After Kidney Transplantation
title The Tacrolimus Concentration/Dose Ratio Does Not Predict Early Complications After Kidney Transplantation
title_full The Tacrolimus Concentration/Dose Ratio Does Not Predict Early Complications After Kidney Transplantation
title_fullStr The Tacrolimus Concentration/Dose Ratio Does Not Predict Early Complications After Kidney Transplantation
title_full_unstemmed The Tacrolimus Concentration/Dose Ratio Does Not Predict Early Complications After Kidney Transplantation
title_short The Tacrolimus Concentration/Dose Ratio Does Not Predict Early Complications After Kidney Transplantation
title_sort tacrolimus concentration/dose ratio does not predict early complications after kidney transplantation
topic Health Archive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10203205/
https://www.ncbi.nlm.nih.gov/pubmed/37229240
http://dx.doi.org/10.3389/ti.2023.11027
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